If you are a new client, please print and complete the following forms and bring them to your first therapy session. Filling out the forms prior to your first session saves us considerable time, providing you a better opportunity to share your reasons for coming into therapy.
- Disclosure statement
- HIPAA Notice & Acknowledgement
- Fee Contract
- Client Information
- Insurance Information
- Credit Card Authorization
In addition to the forms listed above, if you would like me to coordinate care with another provider (for example: your psychiatrist, primary care physician, etc.), then you will also need to complete this form to authorize release of psychotherapy information and bring it with you to your first therapy session.
- Release of Information
|HIPAA - Notice of Provider Practices + Acknowledgement|
| Insurance Information
|Release of Information|
|Credit Card Authorization|
Note: To download Adobe Acrobat Reader for free, click here.